CDI Week Q&A preview: Query practice & compliance

As part of the sixteenth annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Coral F. Fernandez, RN, CCDS, CCS, the system CDI auditor/educator at Baptist Health System in Kentucky, answered these questions. Fernandez is a member of the ACDIS Furthering Education Committee and the CDI Educators Networking Group. For questions about the committee or the Q&A, contact ACDIS Editor Jess Fluegel (jess.fluegel@hcpro.com).

Q: According to the 2026 CDI Week Industry Survey results, most respondents report that an average inpatient CDI specialist completes 6-10 patient new reviews per day (62.50%), followed by an average of 11-15 reviews (18.06%). In comparison, 57.87% are expected to complete 6-10 new reviews by their department, while 22.38% are expected to complete 11-15 reviews. How does your CDI program handle chart review expectations with its staff? Do you think a specific goal can be helpful, and/or are there other metrics helpful to track? Why or why not?

A: A CDI program should have a specific goal for productivity expectations. It is important that CDI specialists know that working one or two encounters an hour is not sufficient. That said, some reviews naturally take longer than others. It is better to think about productivity metrics over a period of time rather than, say, daily. Everyone has days during which they aren’t as productive and other days when they are much more so. We compare productivity metrics within our organization rather than relying too much on “national metrics” because the CDI specialists within our organization are all using the same software and have all had the same education presented to them.

Yes, there are other metrics that are helpful to track. Productivity means less when queries aren’t well-written. Query compliance, concurrent vs. retrospective query rates, DRG/principal diagnosis assignment accuracy, and missed opportunities for queries are all important metrics as well.

Q: Survey results showed 31%-40% was the most common personal average query rate (i.e., the percentage of charts that have at least one query opportunity found during CDI review) reported by respondents, followed by 21-30%, though results otherwise were spread evenly across the board. Can tracking your personal average query rate be beneficial? Why or why not? What other ways can CDI professionals personally measure success?

A: Yes, tracking your personal average query rate can be beneficial when comparing it to other CDI specialists in your facility or healthcare system. “Measuring success” has long been a subject of much discussion in CDI, both from an individual standpoint and for a group. Numbers don’t always tell the whole story, do they?

As an educator, I think that query compliance is an underrated metric. Query compliance rate is measurable and “addressable = educatable.” Anyone who writes CDI queries will occasionally write a noncompliant query. Being able to provide continuing education regarding query compliance means being able to provide concrete feedback to individual CDI specialists as well as to a group. If queries are noncompliant, does it matter what the query rate is?

That said, there should be some feedback to the individual regarding compliant queries as well—no one benefits from only hearing about what was done incorrectly.

Q: According to survey results, 31-40% was the most common query rate goal of CDI departments, followed by 21-30%, though the third most common response indicated that their department doesn’t have a set expectation. Does your CDI program have a specific goal and if so, how was that number decided on? What other strategies can a CDI program use to encourage personal accountability and best query practices?

A: We do not have a set expectation for the number of queries sent per CDI specialist under a certain timeframe. Having a set expectation for the number of queries sent encourages digging around in encounters finding something to query, which is not a great way for a professional to spend their time, and encourages sending queries that aren’t necessary to the accurate and complete assignment of ICD-10 codes. Additionally, this type of querying contributes to query fatigue.

Continuing education regarding query compliance and feedback regarding query compliance can, in my opinion, encourage individual professional accountability and best query practices, both for individual CDI specialists and for the team. As advised in the Guidelines for Achieving a Compliant Query Practice, my organization used this document as a prime resource to write our system policy regarding CDI queries.

CDI practice aligns very well with the practice of nursing. You wouldn’t enter a patient’s room with a urinary catheter kit planning to use the kit without knowing the clinical rationale behind what you are doing and being able to explain it. Likewise, a CDI professional should understand the rationale behind the need for a query prior to sending that query. Make sure you know what you’re doing and why you’re doing it.

According to the Guidelines, “Queries are not necessary for every discrepancy or unaddressed documentation issue.” Understanding the “why” as well as the “why not” can help the individual CDI specialist decide whether a query is prudent or necessary or not. Maintaining a good working relationship with the coding department is very helpful in determining whether a query should be sent. Discussion with coding professionals can help the CDI professional to see documentation from another point of view.

Q: When asked what types of queries they send on a weekly basis, the three most popular types selected by respondents were clinical validation (88.89%), any clarification of documentation required (83.18%), and uncertain diagnoses (70.52%). In the free responses section, conflicting documentation and risk adjustment were also mentioned by many respondents. Which types of queries do you and/or your team focus on? Have there been any you’ve branched out to in recent years (quality measure criteria, problem list verification, etc.)? If so, do you have any tips for writing these types of queries?

A: Our CDI team reviews for patient safety indicators and performs mortality reviews. We also get regular feedback from our colleagues who write appeal letters. This helps us all stay focused on what we’re doing and why we’re doing it.

I’m sure our areas of focus are typical of the industry: clinical validation, sepsis, respiratory failure, “uncertain” diagnoses not restated at discharge, risk adjustment diagnoses, etc.

Regarding queries for conflicting documentation, I think the very best way to do this is to lay out the scenario with clinical indicators, include the specific issue with documentation, and ask the question. Writing a query in this fashion can also serve as provider education. For example:

 Consultant X documented A, your progress note(s) include(s) B … Please clarify:

• A
• B
• Other (please specify) _______________

My best tip for query composition is to make them concise and clear. Extraneous information isn’t necessary unless it’s pertinent to exactly what is being asked.

I write my query and then proofread and edit. I want to make sure what I’ve written is clear and that what I’m asking is supported in the body of the query and that my grammar is top notch. I often find that I can remove some of what I’ve included in the query on my first draft and still have a compliant and well-written query.

Q: When asked if their organization has an escalation policy or other policy requiring physicians to respond to queries/CDI clarifications, about 90% of respondents said they do, continuing a slow but steady increase year-over-year since the first time ACDIS asked this question. Most respondents said their physician advisor is at the top of their query escalation process (34.57%), followed by senior leadership/C-suite (27.01%). Does your CDI program have a query escalation policy, and if so, how is it structured, and what have been your struggles and successes while using it? If not, what other tactics do you have in place to increase response rates? What advice would you give a CDI program wanting to improve or create such a policy?

A: We do have an escalation policy. Once the CDI specialist has made two contacts, the manager(s) assume responsibility for further attempts. We also suspend providers for unanswered CDI queries as “incomplete records.” With administrative support this has been very successful. Administration understands the importance of the CDI program, its goals, and its successes.

Q: This year, the most-used CDI software solution by respondents was computer-assisted coding (79.10%), surpassing chart prioritization (74.09%) and electronic grouper software (73.06%). What kind of software solutions would you say have become common practice to use by CDI departments, and which, if any, have you noticed growing in popularity over the last few years? What type(s) has your organization implemented, and have they impacted your query process? How do you think evolving technology has affected query compliance now and in the future?

A: We have worked extensively with our software vendor to optimize how their product works in our environment. Computer-suggested coding is marvelous, but it is a tool. No software replaces a clinically educated, trained, and experienced human brain. If CDI practice was a matter of clicking buttons, then there would be no need for CDI. I don’t think evolving technology has affected query compliance.